Public Health 101: Upstream Interventions

What does it look like when we cultivate health and prioritize personal liberty? Embodying these values requires civic-mindedness and a public health approach, using preventative, cost-effective strategies to support mental, physical, and economic wellbeing over the course of an individual’s lifetime. Early childhood interventions, supportive employment, education and housing; access to quality care, which contributes to mental and physical health; and successful integration into the workforce and economy. Population health management interventions such as these address the causes of poor behavioral health and crime at their roots.

Equitas envisions youth-focused efforts taking place when the very first “little pink flags” of mental distress appear, well before any “red flags” or full-blown crises. At a young age, the fundamental structure of a child’s brain is malleable and resilient enough to adapt following exposure to traumas and other setbacks. Much like saving for retirement, investing earlier in young people yields verifiably better returns. According to the Heckman Lifecycle Benefits Study, every dollar spent providing a disadvantaged child with high-quality education yields at least $7’s worth of social benefit. These savings come from reduced criminal justice system involvement, increased educational achievement, higher lifetime earnings, improved health outcomes, and higher parental labor income.

While early childhood interventions are key, stakeholders and advocates should be wary of concentrating on children’s issues only. National Institutes of Health research notes that although some disorders emerge during childhood, most high prevalence disorders emerge during adolescence and early adulthood. When treated early, the severity and persistence of these illnesses can be mitigated, so communities must also consciously invest in services for people within the vulnerable age range, ending at age 30. At the age of 18, across the country, newly-minted adults may suddenly be released from state or parent responsibility during a time when they are greatly at risk for developing a mental illness. Supportive interventions must be in place to address the gap years in mental health care and access.

When first responders are called upon to help those in crisis, vulnerable young adults too often become ensnared in a system designed to punish and stigmatize, rather than to support positive health outcomes and successful community integration. In most incarceration settings, even those without behavioral health disorders fight uphill battles to reach their potential for recovery and self-improvement. Add to that the inadequate mental health support provided for people in jails due to budget limitations and overcrowding, and the outcomes are unsurprisingly bleak. Unfortunately, jails are the primary mental health facilities in most states.

When American communities disproportionately incarcerate the most vulnerable people, they fail to address underlying traumas and disadvantages at the root of behaviors. Many laws disproportionately target those with mental illness, the homeless, and the poor. Crimes of survival, trespassing, loitering, and drug possession are just a few examples of crimes which can be seen as symptoms of poor individual and community health, rather than as evidence of criminal intent. If communities use effective and restorative pathways to support the mental and behavioral health of the most vulnerable populations, and reserve prosecution and incarceration for the decidedly criminal, we will see reduced incarceration rates and greater health outcomes, and come much closer to embodying American values.

Across the country, from jurisdiction to jurisdiction, stakeholders in behavioral health and criminal justice are beginning to acknowledge the behavioral health needs of the most vulnerable populations; intervening more efficiently and compassionately when behavioral crises threaten the individuals themselves, or public safety; stepping up to reduce the incarceration of the mentally ill; and enacting measures to treat root traumas and reduce recidivism. However, no community engages those in need along this entire continuum, or addresses all points systematically.

Equitas works both in our home state of Colorado and across the country to activate and promote leaders who understand that long-term population health management requires preventive upstream interventions in addition to health and reentry supports for the justice-involved. In Colorado, Governor John Hickenlooper has committed to exploring upstream strategies and improving access to behavioral health care. Equitas is honored to be a part of the Governor’s new task force charged with addressing gaps in care and improving service delivery. Members will establish bold goals to reduce incarcerated populations and identify investments in alternatives and appropriate care in order to reach them. We are engaging stakeholders in an exciting time. Colorado is one of many places where great work is being done to disentangle behavioral health from the legal system. Visit our website and Twitter feed for exciting updates on regional and national investments in justice, health, and prosperity for all.